A 34-year-old HIV-positive patient (CD4 count 60 cells/µL) with fever, productive cough, and night sweats has a sputum AFB smear that is 2+ positive. Xpert MTB/RIF assay detects MTB and reports rifampicin resistance (rpoB mutation). What should be the IMMEDIATE next step?
- A Start MDR-TB regimen (Bedaquiline, Pretomanid, Linezolid) pending line probe assay for second-line resistance ✓
- B Repeat sputum smear on three consecutive days before initiating any treatment
- C Perform serum galactomannan assay to rule out aspergillosis
- D Initiate Category I DOTS treatment and await culture results
Correct answer: A. Start MDR-TB regimen (Bedaquiline, Pretomanid, Linezolid) pending line probe assay for second-line resistance
Explanation
Xpert MTB/RIF detecting rifampicin resistance is sufficient presumptive evidence for MDR-TB (since isolated rifampicin resistance is rare, it is a proxy for MDR-TB). Per RNTCP/NTEP guidelines the patient should be registered as presumptive MDR-TB and started on an appropriate regimen (now BPaL or conventional MDR regimen) while Line Probe Assay (FL-LPA or SL-LPA) is performed to characterise full resistance profile. Category I DOTS is contraindicated in rifampicin-resistant cases.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.